Checkup: 5 Tips to Get the Best Hospital Care

Sept. 15, 2008

ESSAY by MARIE SAVARD, M.D.ABC News Medical Contributor

I was a nurse before becoming a doctor. When I started out as a nurse more than 30 years ago, the hospital was a place for people to rest and recover from illness. The average hospital stay was more than one week and nurses were plentiful.

While hospitals still provide extraordinary technology and care, people today are admitted to the hospital only when absolutely necessary and for as short a time as possible. And although the nursing staff is better trained than ever to handle just about anything, the day-to-day "nursing" care, such as taking vital signs and helping with bathing and eating, often falls to nursing assistants.

Chances are either you or someone you know will end up in the hospital at some point, so knowing in advance how to prepare and what to do are critical. Thousands of medical mishaps occur during a hospital stay that can be avoided. By following five important steps, you can be assured you are doing what you can to give your loved one the best care possible.

1. Come armed with as much medical information as possible. Bring all your medical records, list of medication doses and directions, allergies and living will. Let me stress the importance of keeping your own medical file, including copies of laboratory tests, X-ray reports and doctor consultations. Don't count on the doctors having ready access to your past medical history.

2. Have a "health buddy." If you are admitted for an extended hospital stay, have a friend or relative stay with you 24 hours a day -- a "health buddy." My sister, my mother and I took turns being with my dad while he recovered from heart bypass surgery. You don't need to have special knowledge. Nobody cares as much as you do about your own family and friends. Your buddy can ask questions, take notes, and clarify what is being done and why. As the patient, you may think of this as a burden to your family or friends. Trust me, in time of need, your family and friends will only be too glad to help out.

3. Identify the doctor in charge. On a typical day, you may see your family doctor, many specialists, your surgeon or anesthesiologist -- and an ever-changing cast of staff. Conflicting information is not uncommon. You need a point person to explain what is happening and answer questions; usually that person is the doctor in charge of your case, the attending physician. Ask your nurse who the doctor is and get his or her phone number. Learn when that person makes hospital rounds and plan to be there to ask your questions. This often means getting to the hospital at an early hour, but it is worth it.

Simple Advice for Protecting Your Health at the Hospital

4. Help the nursing staff. Each day your assigned nurse will get a "plan of care" listing dietary restrictions, the tests scheduled, medications and other special orders from your doctor. Ask the nurse to review the plan of care and medications with you. Take notes if you need to. I knew my dad was not to eat before a certain test and reminded the dietary staff who mistakenly brought him a meal. Keep your own "progress notes" listing your observations and questions in a tablet at the bedside for everyone to see.

5. Help with discharge planning and get a copy of your discharge summary. Patients are often sent home from the hospital still sick with new and complicated treatments. This time of transition is when many medical mistakes happen. Make sure you understand exactly what you still need to continue to help your loved one get better. Talk to the doctor(s), your nurse and even a pharmacist if you are taking new medication. Ask if you should resume the old medication you were taking before coming into the hospital.

Other Tips to Consider

Don't hesitate to ask questions and have your answers recorded (with permission) or written down. Your attending doctor will dictate a complete report summarizing the reason for your hospital stay, any treatment and test results. Ask your doctor for a copy of this discharge summary and provide a self-addressed stamped envelope as a reminder of your request. Ask your surgeon for a copy of the operative summary for your files as well.

Ask for copies of important tests or findings such as EKG blood work or X-rays. They may be important to your doctor in case of a problem after you go home, especially if you were not seen or treated by your family doctor while in the hospital. My friend insisted on a copy of her sister's EKG and heart catheterization report after leaving a hospital because she was admitted to the hospital on an emergency basis while on vacation. She developed chest pain while en route, and the information helped her doctors know how to treat her. This information may have saved her life.

Your Experiences With Staying Healthy in the Hospital

Have you cared for someone recently in the hospital? What advice do you have to give others? As always, I welcome your questions and comments.

Dr. Marie Savard is an ABC News medical contributor. To learn more about Savard's health management system, download free forms and a sample letter to your doctor, visit http://www.drsavard.com and click on "Learn how to take charge of YOUR health."

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